摘要
目的分析致盲性视神经脊髓炎谱系疾病相关视神经炎的临床和免疫学特征,探讨影响视功能预后的预测因素。设计回顾性病例系列。研究对象2018-2022年北京同仁医院45例致盲性视神经脊髓炎谱系疾病相关视神经炎患者。方法根据6个月后Wingerchuk视力分级分为预后不良组(27例)和预后良好组(18例)。对两组患者人口特征、症状、实验室及影像学检查、治疗方法、治疗后6个月视力改善情况进行对比分析。主要指标临床表现及视力改善情况。结果预后不良组的视神经受累长度大于1/2比例更高(P=0.009),血清学免疫抗体阳性率较低(P=0.028),甲强龙冲击治疗距发病时间更长(P=0.032)。Logistic回归显示,视神经受累长度大于1/2(OR=16.247,95%CI:10.834~24.363;P<0.01)、血清学免疫抗体阴性(OR=13.965,95%CI:9.465~20.603;P<0.01)、甲强龙冲击治疗距发病时间(OR=1.107,95%CI:1.075~1.139;P<0.01)是预后不良的危险因素。ROC曲线分析显示甲强龙冲击治疗距发病时间大于7天预测不良预后的ROC曲线下面积(AUC)为0.794(P=0.001,95%CI:0.659-0.928)。结论致盲性视神经脊髓炎谱系疾病相关视神经炎视功能恢复较差,甲强龙冲击治疗时间与预后密切相关。
Objective To analyze the clinical and immunological features of blinding neuromyelitis optica spectrum disorders associated optic neuritis,and to explore the predictive factors of visual function prognosis.Design Retrospective case series.Participants Patients with blinding neuromyelitis optica spectrum disorders related optic neuritis admitted to our department from 2018 to 2022 were enrolled.Methods The patients were divided into poor prognosis group(27 cases)and good prognosis group(18 cases).The demographic characteristics,symptoms,laboratory and imaging examinations,treatment methods,and visual acuity improvement at 6 months after treatment were compared between the two groups.Main Outcome Measures Clinical features,visual acuity improvement.Results In the poor prognosis group,the proportion of patients with optic nerve involvement longer than half was higher(P=0.009),the positive rate of serum immune antibody was lower(P=0.028),and the time from onset to methylprednisolone pulse therapy was longer(P=0.032).Logistic regression showed that the length of optic nerve involvement greater than 1/2(OR=16.247,95%CI:10.834-24.363,P<0.01),serological immune antibody negative(OR=13.965,95%CI:9.465-20.603,P<0.01),the time from onset of methylprednisolone pulse therapy(OR=1.107,95%CI:1.075-1.139,P<0.01)were the risk factors for poor prognosis.ROC curve analysis showed that the area under the ROC curve(AUC)for predicting poor prognosis was 0.794(P=0.001,95%CI:0.659-0.928)when the time from onset was more than 7 days.Conclusions The prognosis of blinding neuromyelitis optica spectrum disorders associated with optic neuritis is poor,and the duration of methylprednisolone pulse therapy is closely related to the prognosis.
作者
杨庆林
孙厚亮
孟超
王佳伟
Yang Qinglin;Sun Houliang;Meng Chao;Wang Jiawei(Department of Neurology,Tongren Hospital,Capital Medical University,Beijing 100730,China)
出处
《眼科》
CAS
2023年第5期392-396,共5页
Ophthalmology in China
关键词
视神经脊髓炎
视神经炎
预后
neuromyelitis optica
optic neuritis
prognosis
